A Different Surge? Vaccinated Patients Seeking Non-COVID Care

Ken Terry

April 14, 2021

A recent analysis of national hospital data indicates that a greater proportion of vaccinated people than of nonvaccinated people are now seeking hospital care for serious conditions, suggest researchers from Strata Decision Technology.

However, Vikas Parekh, MD, a professor of internal medicine and associate chief medical officer-health system for Michigan Medicine in Ann Arbor, told Medscape Medical News that the data were insufficient to support that assumption.

According to the Strata report, which was based on data from 352 client hospitals, patient volumes in hospitals and health systems were up across the country in March.

One telling component of that resurgence, the report noted, was a 7.5% increase in observation visit activity over the prior 30 days. The Strata researchers focused on this data point because COVID-19 patients are not normally placed under observation; instead, they're admitted to the hospital.

The researchers dug into the observation data, comparing the increase in those visits by patients older and younger than age 65. This data, which doesn't appear in the report but was supplied to Medscape Medical News, shows a clear difference between the two age groups.

For example, observation visits for noncardiac chest pain increased 12.4% for people older than 65 and 8.6% for younger patients; rose 14% and 10.5%, respectively, for coronary heart disease; grew 22.9% and 4.5%, respectively, for congestive heart failure; and for arrhythmia, jumped 23.7% for the over-65 cohort while dropping 0.4% in the under-65 group.

The majority of Americans older than 65 had been vaccinated through the end of March: Nearly 75% of them had gotten at least one shot by April 2, and 53.5% had been fully vaccinated, according to Centers for Disease Control and Prevention (CDC) data cited by Newsweek.

In contrast, a much lower percentage of people younger than 65 had been vaccinated by then. So the Strata researchers theorized that vaccination was the reason why more seniors were going to hospitals for reasons unrelated to COVID-19.

The researchers also noted that, in contrast to the March rise, observation visits among people over 65 had dropped 16% in January and 9.3% in February. This supported their view that the change was related to the vaccination effort ramping up at that time.

"As people are getting vaccinated, things are returning to normal. They're going for routine screenings that are more invasive, and they're willing to go to the hospital if something is seriously wrong," said Steve Lefar, executive director of StrataDataScience, a division of Strata Decision Technology, in an interview with Medscape Medical News. "That's a sign that confidence is returning and care is returning to normal."

Vaccination Not Only Factor

Parekh said that "it's a plausible hypothesis of why they're seeing an increase [in observation visits] in the older age group. But the diagnoses in the analysis, such as chest pain, arrhythmia, and CHF, all tend to be more common in elderly populations. So it's hard to say that's the only factor.

"These data aren't too surprising," added Parekh, who does capacity management for his health system and is in close communication with colleagues in other Michigan health systems.

"Locally and in the state, we've all noticed that more typical care is coming back into our hospitals, and our hospitals have been busier, especially over the last 4-6 weeks. This data fits with that. I suspect vaccination is partly responsible. Also, in February and March, most of the country was coming out of the bottom of a COVID wave, and people were feeling better about COVID," Parekh said.

As states reopened restaurants, gyms, and schools, he said, "life was feeling more normal to people, and with that came a willingness to seek care that had previously been deferred. Most of that deferred care was lower acuity, less emergent care. We didn't think much emergent care was being deferred any more, although that might have been the case a year ago."

Picture Varies Across Care Settings

Overall, the Strata report showed a 30-day increase in March of 1.5% in inpatient admissions, 7.5% in observation visits, 6.1% in emergency department visits, and 6.5% in outpatient visits.

These changes varied quite a bit by region. In the South, for example, inpatient visits were down 0.1% while observation visits increased 10.3%, emergency visits rose 5.8%, and outpatient visits grew 3.5%.

The growth in hospitals' inpatient and emergency volumes didn't restore these activities to pre-pandemic levels, the report noted. "We have seen some restoration in ER volumes that were down 50%-plus at the peak, and now they're down substantially less than that," Lefar said. "But people are still a bit wary about going to the ER, so ER visits have flattened a little bit. We were down 50% a year ago, and now we're down 25% [from the pre-pandemic level]."

In contrast, he said, "outpatient visits are up dramatically, because they include vaccinations in some health systems. Some prevention and screening visits are in there, too. Outpatient is actually above where we were in January and February last year, even without counting telehealth visits. We know that's people catching up on care and some vaccinations. That's the only [care setting] that has recovered fully."

Parekh said, "That fits with what we've heard and seen. More typical routine deferred care has come back, especially since the last COVID wave. Ambulatory activity has largely returned to pre-COVID levels, with a few gaps such as pediatrics."

Current ED visits, he said, "are the highest we've seen since January 2020. That's in part driven by the COVID wave in Michigan. But there's also a lot of non-COVID care in there." About 10%-12% of ED volume statewide now consists of COVID-19 patients, he added.

The number of COVID-19 hospitalizations in Michigan recently surpassed their fall peak. To what extent has that surge suppressed the number of people seeking care in the EDs of Michigan hospitals?

"It's hard to differentiate that, because we're in the midst of this huge COVID wave," Parekh said. "But before this surge, ED activity was at about 95% of what it had historically been. And what was missing was low-acuity, nonemergent ED visits. We wondered whether that might be a long-term shift. Now we're in the COVID wave, and activity is through the roof. But we're still not seeing low-acuity cases like ankle sprains."

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